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This study aimed to investigate the effects of esketamine (Esk) combined with dexmedetomidine (Dex) on postoperative delirium (POD) and quality of recovery (QoR) in elderly patients undergoing thoracoscopic radical lung cancer surgery.
Methods
In this prospective, randomized, and controlled study, 172 elderly patients undergoing thoracoscopic radical lung cancer surgery were divided into two groups: the Esk + Dex group (n = 86) and the Dex group a (n = 86). The primary outcome was the incidence of POD within 7 days after surgery and the overall Quality of Recovery−15 (QoR − 15) scores within 3 days after surgery. Secondary outcomes included postoperative adverse reactions, extubation time, PACU stay, and hospitalization time. Serum levels of IL-6, IL-10, S100β protein, NSE, CD3+, CD4+, and CD8+ were detected from T0 to T5.
Results
Compared with the Dex group, the incidence of POD in the Esk + Dex group was significantly lower at 7 days after surgery (14.6% vs 30.9%; P = 0.013). The QoR − 15 score was significantly increased 3 days after surgery (P < 0.01). Levels of IL-6 and CD8+ were significantly decreased, and IL − 10 levels were significantly increased at T1-T2 (P < 0.05). At T1-T4, NSE levels were significantly decreased, while CD3+ and CD4+/CD8+ values were significantly increased (P < 0.01). At T1-T5, serum S100β protein concentration decreased significantly, and CD4+ value increased significantly (P < 0.01). The incidence of nausea/vomiting and hyperalgesia decreased significantly 48 hours after surgery (P < 0.01). The duration of extubation, PACU stay, and postoperative hospitalization were significantly shortened.
Conclusions
Esketamine combined with dexmedetomidine can significantly reduce the POD incidence and improve the QoR in patients undergoing thoracoscopic radical lung cancer surgery, which may be related to the improvement of cellular immune function.
Plant–soil interactions have bottom–up and top–down effects within a plant community. Heavy metal pollution can change plant–soil interactions, directly influence bottom–up effects and indirectly affect herbivores within the community. In turn, herbivores can affect plant–soil interactions through top–down effects. However, the combined effects of heavy metals and herbivores on soil enzymes, plants and herbivores have rarely been reported. Therefore, the effects of lead (Pb), Spodoptera litura and their combined effects on soil enzyme activities, pakchoi nutrition, defence compounds and S. litura fitness were examined here. Results showed that Pb, S. litura and their combined effects significantly affected soil enzymes, pakchoi and S. litura. Specifically, exposure to double stress (Pb and S. litura) decreased soil urease, phosphatase and sucrase activities compared with controls. Furthermore, the soluble protein and sugar contents of pakchoi decreased, and the trypsin inhibitor content and antioxidant enzyme activity increased. Finally, the S. litura development period was extended, and survival, emergence rates and body weight decreased after exposure to double stress. The combined stress of Pb and S. litura significantly decreased soil enzyme activities. Heavy metal accumulation in plants may create a superposition or synergistic effect with heavy metal-mediated plant chemical defence, further suppressing herbivore development. Pb, S. litura and their combined effects inhibited soil enzyme activities, improved pakchoi resistance and reduced S. litura development. The results reveal details of soil–plant–herbivore interactions and provide a reference for crop pest control management in the presence of heavy metal pollution.
Autonomous exploration in unknown environments has become a critical capability of mobile robots. Many methods often suffer from problems such as exploration goal selection based solely on information gain and inefficient tour optimization. Recent reinforcement learning-based methods do not consider full area coverage and the performance of transferring learned policy to new environments cannot be guaranteed. To address these issues, a dual-stage exploration method has been proposed, which combines spatial clustering of possible exploration goals and Traveling Salesman Problem (TSP) based tour planning on both local and global scales, aiming for efficient full-area exploration in highly convoluted environments. Our method involves two stages: exploration and relocation. During the exploration stage, we introduce to generate local navigation goal candidates straight from clusters of all possible local exploration goals. The local navigation goal is determined through tour planning, utilizing the TSP framework. Moreover, during the relocation stage, we suggest clustering all possible global exploration goals and applying TSP-based tour planning to efficiently direct the robot toward previously detected but yet-to-be-explored areas. The proposed method is validated in various challenging simulated and real-world environments. Experimental results demonstrate its effectiveness and efficiency. Videos and code are available at https://github.com/JiatongBao/exploration.
White matter hyperintensities (WMH) is common among the elderly. WMH are associated with accelerated cognitive dysfunction and increased risk for Alzheimer`s disease (AD). Although WMHs play a key role in lowering the threshold for the clinical expression of dementia in AD-related pathology, the clinical significance of their location is not fully understood.
Objectives
The aim of this study was twofold: 1) To investigate the quantitative association between WMH and cognitive function in AD; 2) To investigate whether there is any difference in the association between subclassified WMH and cognitive function in AD.
Methods
A total of 171 patients with AD underwent clinical evaluations including volumetric brain MRI study and neuropsychological tests using the CERAD-K neuropsychological assessment battery. WMH volume was calculated using automated quantification method with SPM and MATLAB image processing software. According to the distance from the lateral ventricular surface, WMH within 3 mm, WMH within 3-13 mm, and WMH over 13 mm were classified as juxtaventricular WMH (JVWMH), periventricular WMH (PVWMH) and deep WMH (DWMH), respectively. WMH volume data was logarithmically transformed because it was right-skewed.
Results
WMH volume in AD was 20.7 ± 18.2 ml. Total WMH volume was associated with poor performance in categorical verbal fluency test (p = 0.008) and word list memory test (p = 0.023). JVWMH volume was associated with poor performances on categorical verbal fluency test (p = 0.013) and forward digit span test (p = 0.037). PVWMH volume was associated with poor performances on categorical verbal fluency test (p = 0.011) and word list memory test (p = 0.021), whereas DWMH volume showed no association with cognitive tests. Total WMH and PVWMH volume were also related to Clinical Dementia Rating scale sum of boxes score (p=0.022).
Image:
Conclusions
Greater JVWMH and PVWMH are related with concurrent impairments in semantic memory and frontal function independent of the hippocampal volume. However, DWMH volume is not associated with any cognitive function. Only PVWMH among subclassified WMH are related to the severity of AD.
This study investigates the impact of molecular thermal fluctuations on compressible decaying isotropic turbulence using the unified stochastic particle (USP) method, encompassing both two-dimensional (2-D) and three-dimensional (3-D) scenarios. The findings reveal that the turbulent spectra of velocity and thermodynamic variables follow the wavenumber (k) scaling law of ${k}^{(d-1)}$ for different spatial dimensions $d$ within the high wavenumber range, indicating the impact of thermal fluctuations on small-scale turbulent statistics. With the application of Helmholtz decomposition, it is found that the thermal fluctuation spectra of solenoidal and compressible velocity components (${\boldsymbol {u}}_{s}$ and ${\boldsymbol {u}}_{c}$) follow an energy ratio of 1 : 1 for 2-D cases, while the ratio changes to 2 : 1 for 3-D cases. Comparisons between 3-D turbulent spectra obtained through USP simulations and direct numerical simulations of the Navier–Stokes equations demonstrate that thermal fluctuations dominate the spectra at length scales comparable to the Kolmogorov length scale. Additionally, the effect of thermal fluctuations on the spectrum of ${\boldsymbol {u}}_{c}$ is significantly influenced by variations in the turbulent Mach number. We further study the impact of thermal fluctuations on the predictability of turbulence. With initial differences caused by thermal fluctuations, different flow realizations display significant disparities in velocity and thermodynamic fields at larger scales after a certain period of time, which can be characterized by ‘inverse error cascades’. Moreover, the results suggest a strong correlation between the predictabilities of thermodynamic fields and the predictability of ${\boldsymbol {u}}_{c}$.
Motivated by practical applications of inspection and maintenance, we have developed a wall-climbing robot with passive compliant mechanisms that can autonomously adapt to curved surfaces. At first, this paper presents two failure modes of the traditional wall-climbing robot on the variable curvature wall surface and further introduces the designed passive compliant wall-climbing robot in detail. Then, the motion mechanism of the passive compliant wall-climbing robot on the curved surface is analyzed from stable adsorption conditions, parameter design process, and force analysis. At last, a series of experiments have been carried out on load capability and curved surface adaptability based on a developed principle prototype. The experimental results indicated that the wall-climbing robot with passive compliant mechanisms can effectively promote both adsorption stability and adaptability to variable curvatures.
A compact high-power ultra-wideband bipolar pulse generator based on a modified Marx circuit is designed, which is mainly composed of a primary power supply, Marx generator, sharpening and cutoff subnanosecond spark gap switches, and coaxial transmission lines. The Marx generator with modified circuit structure has thirty-two stages and is composed of eight disk-like modules. Each module consists of four capacitors, two spark gap switches, four charging inductors, and a mechanical support. To simplify the design of the charging structure and reduce the number of switches, four groups of inductors are used to charge the capacitors of the Marx generator, two of which are used for positive voltage charging and the other two for negative voltage charging. When the capacitor of each stage is charged to 35 kV, the maximum output peak voltage can reach 1 MV when the Marx generator is open circuit. The high-voltage pulse generated by the Marx generator charges the transmission line and forms a bipolar pulse through sharpening and cutoff switches. All transmission lines used for bipolar pulse generation have an impedance of 10 Ω. When the 950 kV pulse voltage generated by the Marx generator is fed into the transmission line, the bipolar pulse peak voltage can reach 390 kV, the center frequency of the pulse is about 400 MHz, and the output peak power is about 15.2 GW.
The aim of the work was to study the effect of organo-montmorillonite (OMt) on the properties of hydrogenated nitrile rubber (HNBR)/OMt nanocomposites. The nanocomposites were prepared by a melt intercalation method. The structure of the composites was studied by transmission electron microscopy (TEM) and X-ray diffraction (XRD). The behavior of stress-strain, aging resistance, solvent resistance, and the dynamic mechanical properties of HNBR/OMt nanocomposites were investigated. The TEM and XRD results showed that the OMt layers were dispersed homogeneously in the HNBR matrix. The HNBR/OMt nanocomposites showed excellent mechanical properties which were attributed to the nanometer scale dispersion and strong interaction between the HNBR and OMt. The composites possessed excellent aging resistance and oil resistance, which improved with OMt content. Dynamic mechanical analysis showed that the glass-transition temperature, Tg, of the HNBR/OMt nanocomposites was increased and the nanocomposites had a good rolling resistance in comparison to pure HNBR. The composites displayed better dynamic mechanical properties.
Schistosomiasis, a parasite infectious disease caused by Schistosoma japonicum, often leads to egg granuloma and fibrosis due to the inflammatory reaction triggered by egg antigens released in the host liver. This study focuses on the role of the egg antigens CP1412 protein of S. japonicum (SjCP1412) with RNase activity in promoting liver fibrosis. In this study, the recombinant egg ribonuclease SjCP1412, which had RNase activity, was successfully prepared. By analysing the serum of the population, it has been proven that the anti-SjCP1412 IgG in the serum of patients with advanced schistosomiasis was moderately correlated with liver fibrosis, and SjCP1412 may be an important antigen associated with liver fibrosis in schistosomiasis. In vitro, the rSjCP1412 protein induced the human liver cancer cell line Hep G2 and liver sinusoidal endothelial cells apoptosis and necrosis and the release of proinflammatory damage-associated molecular patterns (DAMPs). In mice infected with schistosomes, rSjCP1412 immunization or antibody neutralization of SjCP1412 activity significantly reduced cell apoptosis and necroptosis in liver tissue, thereby reducing inflammation and liver fibrosis. In summary, the SjCP1412 protein plays a crucial role in promoting liver fibrosis during schistosomiasis through mediating the liver cells apoptosis and necroptosis to release DAMPs inducing an inflammatory reaction. Blocking SjCP1412 activity could inhibit its proapoptotic and necrotic effects and alleviate hepatic fibrosis. These findings suggest that SjCP1412 may be served as a promising drug target for managing liver fibrosis in schistosomiasis japonica.
Recurrent laryngeal nerve (RLN) injury has been a frequent source of malpractice litigation following thyroid surgery. Intraoperative neural monitoring (IONM) has been widely applied to avoid RLN injury in thyroid surgery in developed countries, but China cannot achieve the same application rate currently. To improve the recognition and application of IONM in China, this literature review aims to synthesize the evidence on the value of IONM in China.
Methods
A comprehensive literature review was conducted by searching through PubMed, CNKI and Wan Fang to identify studies about the IONM technology for protecting RLN during thyroid surgery in Chinese clinical data.
Results
Nineteen Chinese clinical trials of IONM during thyroid surgery published from 2012 to 2022 were included for review. Almost all studies recruited adults who need thyroid surgery and only one study enrolled geriatric patients. There were three (3/19) prospective studies and two were randomized controlled trials that both showed that IONM helped surgeons to detect the RLN with less time and reduce the injury of RLN in reoperative thyroid surgery. Major studies (16/19) conducted retrospective analysis and six of them (6/16) only had an IONM group that showed that IONM technology can avoid damage to the RLN. The remaining ten studies (10/16) compared patients with and without IONM during the surgery. Compared with the non-IONM group, nine studies (9/10) stated IONM technology has an advantage in the reduction of RLN injury rate and seven studies (7/10) claimed IONM was helpful in reducing the time of surgery. One study believed IONM was beneficial to reducing bleeding during the surgery and another study reported a lower incidence of hypoparathyroidism with the IONM group.
Conclusions
The value of IONM for protecting RLN during thyroid surgery and improving operation efficiency has been thoroughly proven by the above Chinese clinical trials. Further economic evaluations and patient-reported outcomes research of IONM with Chinese hospital data will help better assess the value of IONM.
Neocinnamomum plants are evergreen shrubs or small trees belonging to the Neocinnamomeae tribe of the Lauraceae family. Their seeds are rich in fatty acids, and their leaves are often used in traditional Chinese medicine. Presently, only a few studies have been performed on Neocinnamomum plants; therefore, the genome-based phylogeny among Neocinnamomum species has not been determined, which limits the germplasm innovation of this genus. In this study, by the Illumina (next-generation sequencing) and third-generation sequencing technologies, the whole genomes of seven Neocinnamomum species samples were sequenced, their nuclear DNA (nrDNA) sequences were assembled and characterized, and their phylogeny was reconstructed. The results revealed four hypervariable regions (i.e. transcribed spacer regions) in the nrDNA sequences, among which the highest degree of variation was observed in the external transcribed spacer (ETS) region localized behind the 26S gene. A total of 27 insertions/deletions and 184 single-nucleotide polymorphisms, both localized mainly in the ETS and internal transcribed spacer regions, were identified. Phylogenetic trees were constructed based on the nrDNA sequences using the maximum likelihood (ML) and Bayesian inference (BI) methods with Caryodaphnopsis henryi as the outgroup. The ML tree divided the seven Neocinnamomum species into four clades. Clade I consisted of Neocinnamomum caudatum var. macrocarpum and Neocinnamomum caudatum, clade II included Neocinnamomum delavayi and Neocinnamomum mekongense, clade III included Neocinnamomum fargesii and a branch species of N. delavayi and clade IV included Neocinnamomum lecomtei, constituting a monophyletic and basal group. The BI tree shared the same topological structure as the ML tree, and all the support values of the BI tree were one except for that of one Neocinnamomum species (0.98). The results of this study provide new evidence regarding the phylogenetic evolution of the Neocinnamomum plants.
Inflammation plays a critical role in the progression of chronic liver diseases, and diet can modulate inflammation. Whether an inflammatory dietary pattern is associated with higher risk of hepatic steatosis or fibrosis remains unclear. We aimed to investigate the associations between inflammatory dietary pattern and the odds of hepatic steatosis and fibrosis.
Design:
In this nationwide cross-sectional study, diet was measured using two 24-h dietary recalls. Empirical dietary inflammatory pattern (EDIP) score was derived to assess the inflammatory potential of usual diet, which has been validated to highly predict inflammation markers in the study population. Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were derived from FibroScan to define steatosis and fibrosis, respectively.
Setting:
US National Health and Nutrition Examination Survey.
Participants:
4171 participants aged ≥18 years.
Results:
A total of 1436 participants were diagnosed with S1 steatosis (CAP ≥ 274 dB/m), 255 with advanced fibrosis (LSM ≥ 9·7 kPa). Compared with those in the lowest tertile of EDIP-adherence scores, participants in the highest tertile had 74 % higher odds of steatosis (OR: 1·74, 95 % CI (1·26, 2·41)). Such positive association persisted among never drinkers, or participants who were free of hepatitis B and/or C. Similarly, EDIP was positively associated with CAP in multivariate linear model (P < 0·001). We found a non-significant association of EDIP score with advanced fibrosis or LSM (P = 0·837).
Conclusions:
Our findings suggest that a diet score that is associated with inflammatory markers is associated with hepatic steatosis. Reducing or avoiding pro-inflammatory diets intake might be an attractive strategy for fatty liver disease prevention.
Sedimentary records from the Kumtag (also known as Kumtagh) Desert (KMD) in northwestern China are investigated to better understand Late Quaternary paleoenvironmental changes in this hyper-arid region. Presented here are the results of probably the first systematic survey of sedimentary sequences from the KMD, with the chronology determined by the optically stimulated luminescence dating. The variation of sedimentary facies, supported by granular and geochemical paleoenvironmental proxies, is used to decipher the history of Late Quaternary environment changes. The results demonstrate that a constantly dry condition characterized the eastern KMD since the last glacial maximum, but with occurrences of wetter periods. From ca. 17 to 15 ka, fluvial activity was probably triggered by melting of glaciers in mountains located south of the KMD. A distinctly drier stage (ca. 13–7 ka) was recognized due to the prominent occurrence of aeolian sands. A wetter environment likely persisted between ca. 4.4 and 2.2 ka, consistent with evidence of human activities. While the causes of paleoenvironmental changes in the eastern KMD are still a matter of debate, the melting of glaciers in the Altyn-Tagh Mountains in the south must be considered as an important factor.
We show that demand effects generated by institutional frictions can influence systematic return predictability patterns in stocks and mutual funds. Identification relies on a reform to the Morningstar rating system, which we show caused a structural break in style-level positive feedback trading by mutual funds. As a result, momentum-related factors in stocks, as well as performance persistence and the “dumb money effect” in mutual funds, experienced a sharp decline. Consistent with the proposed channel, return predictability declined right after the reform, was limited to the U.S. market, and was concentrated in factors and mutual funds most exposed to the mechanism.
We document and explain the sharp performance deterioration of smart beta indexes after the corresponding exchange-traded funds (ETFs) are launched for investment. While smart beta is purported to deliver excess returns through factor exposures, the market-adjusted return of smart beta indexes drops from about 3% “on paper” before ETF listings to about −0.50% to −1% after ETF listings. This performance decline cannot be explained by variation in factor premia, strategic timing, or diminishing returns to scale. Instead, we find strong evidence of data mining in the construction of smart beta indexes, which helps ETFs attract flows, as investors respond positively to backtests.
The subduction of the Bangong–Nujiang Ocean is important in the geological evolution of the Tibetan Plateau. In this paper, we report new zircon U-Pb age and Lu-Hf isotopic data and whole-rock elemental and Sr-Nd-Pb isotopic data for Early Cretaceous dacites from the Rena-Co area (RCA) in the southern Qiangtang Terrane (QT), central Tibet and use these data to better understand the tectonic evolution of the Bangong–Nujiang suture. LA–ICP-MS dating of zircons yields ages of 109.5 ± 0.6 Ma to 109.6 ± 0.8 Ma for the dacites from the RCA. Geochemically, these dacites are medium-K calc-alkaline and show high SiO2 contents of 64.79–70.37 wt.%, high Sr contents of 517–598 ppm and low Y contents of 8.45–10.7 ppm, similar to those of typical adakites. Additionally, all the rocks are strongly enriched in light rare earth elements and some large ion lithophile elements (e.g. Rb, U, K and Cs) but significantly depleted in high-field-strength elements (e.g. Nb, Ta and Ti), consistent with the geochemical characteristics of arc-type magmas formed in the subduction zone. Moreover, these adakite-like dacites show whole-rock initial (87Sr/86Sr)i ratios of 0.705119 to 0.705491, (206Pb/204Pb)i ratios of 18.489 to 18.508, (207Pb/204Pb)i ratios of 15.591 to 15.612, (208Pb/204Pb)i ratios of 38.599 to 38.686, ϵNd(t) values of −0.28 to +1.25 and single-stage Nd model ages of 642 to 818 Ma, as well as significantly positive zircon ϵHf(t) values of 3.9–13.1, with young Hf-depleted mantle ages of 331 to 923 Ma. These geochemical and isotopic data indicate that they are most likely derived from the juvenile thickened mafic lower continental crust, which contains partial melts of metasomatized peridotite and subduction-related fluids in the magma source region. Based on previous studies and our new data, we propose that the RCA adakite-like dacites are most likely a result of the northwards subduction of the Bangong–Nujiang Ocean lithosphere beneath the southern QT during the Early Cretaceous and that a slab rollback model could explain the formation of the RCA adakite-like dacites.
In this paper, we study almost proximal extensions of minimal flows. Let $\pi : (X,T)\rightarrow (Y,T)$ be an extension of minimal flows. Then $\pi $ is called an almost proximal extension if there is some $N\in {\mathbb N}$ such that the cardinality of any almost periodic subset in each fiber is not greater than N. When $N=1$, $\pi $ is proximal. We will give the structure of $\pi $ and give a dichotomy theorem: any almost proximal extension of minimal flows is either almost finite to one, or almost all fibers contain an uncountable strongly scrambled subset. Using the category method, Glasner and Weiss showed the existence of proximal but not almost one-to-one extensions [On the construction of minimal skew products. Israel J. Math.34 (1979), 321–336]. In this paper, we will give explicit such examples, and also examples of almost proximal but not almost finite to one extensions.
Using one-dimensional branching Brownian motion in a periodic environment, we give probabilistic proofs of the asymptotics and uniqueness of pulsating traveling waves of the Fisher–Kolmogorov–Petrovskii–Piskounov (F-KPP) equation in a periodic environment. This paper is a sequel to ‘Branching Brownian motion in a periodic environment and existence of pulsating travelling waves’ (Ren et al., 2022), in which we proved the existence of the pulsating traveling waves in the supercritical and critical cases, using the limits of the additive and derivative martingales of branching Brownian motion in a periodic environment.
Although aberrant brain regional responses are reported in social anxiety disorder (SAD), little is known about resting-state functional connectivity at the macroscale network level. This study aims to identify functional network abnormalities using a multivariate data-driven method in a relatively large and homogenous sample of SAD patients, and assess their potential diagnostic value.
Methods
Forty-six SAD patients and 52 demographically-matched healthy controls (HC) were recruited to undergo clinical evaluation and resting-state functional MRI scanning. We used group independent component analysis to characterize the functional architecture of brain resting-state networks (RSNs) and investigate between-group differences in intra-/inter-network functional network connectivity (FNC). Furtherly, we explored the associations of FNC abnormalities with clinical characteristics, and assessed their ability to discriminate SAD from HC using support vector machine analyses.
Results
SAD patients showed widespread intra-network FNC abnormalities in the default mode network, the subcortical network and the perceptual system (i.e. sensorimotor, auditory and visual networks), and large-scale inter-network FNC abnormalities among those high-order and primary RSNs. Some aberrant FNC signatures were correlated to disease severity and duration, suggesting pathophysiological relevance. Furthermore, intrinsic FNC anomalies allowed individual classification of SAD v. HC with significant accuracy, indicating potential diagnostic efficacy.
Conclusions
SAD patients show distinct patterns of functional synchronization abnormalities both within and across large-scale RSNs, reflecting or causing a network imbalance of bottom-up response and top-down regulation in cognitive, emotional and sensory domains. Therefore, this could offer insights into the neurofunctional substrates of SAD.